©January 2011

One of the most palatable features of the “Law of Supply and Demand” is the intuitive notion that the value of something diminishes when you have too much of it.  This phenomenon is easily illustrated by comparing the unwasteful care focused upon a crab leg at the beginning of an all-you-can-eat crab feed compared with the attention garnered by the last crab leg of the evening.  However, in an era that is likely to be seen by our descendents as the “Information Age,” which began with access to newspapers and now at mid-stream is highlighted by the Internet, Facebook, Google, Yahoo, and cell phones smarter than NASA computers of yesteryear, it is worthwhile to remind ourselves that information, like crab meat, is at risk of being devalued by its shear plenty.

From the perspective of public health, the danger that we lose respect for information is no laughing matter.  One of the largest underground activities of public health in this country is the collection and analysis of data relating to our health.  Without this infrastructure the discovery of epidemics or the identification of risk factors that shorten life expectancy or quality of life would be delayed.  By scrutinizing this data according to stringent statistical rules, the public health system wades through a sea of potential and alleged risks in order to identify those that appear to have a causal relationship to illness and select the ones for which practical mitigating measures are available. In this way, every health care and illness prevention dollar can be spent to the greatest public benefit.  There is enormous responsibility inherent in this mission.

First, it is important that the analysis of data be done objectively.  All of the mysterious tools available to statisticians and epidemiologists – coefficients of variance, confidence intervals, t-scores, etc… – should be applied with consistency.  In accordance with a timeless scientific principle, those collecting the data should have no self-interest or pre-judgment about the conclusions of the ultimate findings, within what is humanly possible.  A positive and productive recommendation cannot justify misrepresentation of the data.

Secondly, the importance of credibility cannot be overemphasized when we are talking about the role of public health in the dissemination of information.  Recognizing what we do not know is equally as important as recognizing what we think we know.  The list of historical examples of science doing a poor job of public education and suffering a lack of public support because of it is striking.  More important, serious and unnecessary outbreaks of illness have resulted from such events.  A few examples follow.

The British Medical Journal recently published a report identifying incriminating evidence that the article published in another English journal in 1998 that fueled the anti-vaccine movement was rife with distorted data, misrepresentations and frank conflicts of interest.  These ethical lapses ultimately led to the revocation of the author’s license to practice medicine, but this has not prevented countless deaths resulting from cases of vaccine-preventable illnesses that may have been, at least in part, a result of this misinformation.

The ongoing debate regarding climate change is another example of science falling victim to passion and dogma on both sides of the debate.  While the data is absolutely convincing that unprecedented changes in certain parameters are occurring within the historical records, the interpretation and dissemination of this information needs to follow scientific guidelines, as free from political or self-centered influence as possible.

The recent release of Healthcare Acquired Infection rates for healthcare facilities throughout California is another example.  It was clear to the experts that the rates of infections due to surgical procedures at various hospitals was reported inconsistently between hospitals, under different criteria, and was largely influenced by the patient mix at various hospitals.  Naturally, hospitals receiving a large number of seriously ill patients and burn victims suffered higher infection rates.  Therefore, to the objections of certain consumer groups but in accordance with objective principles, this data was released by the California Department of Public Health with clear disclaimers.

The responsibility to handle information with great respect, of course, extends to all levels of the community.  Whether in debates involving party politics, health reform, climate change, private agencies or public health, maintaining a sense of humility about the data we wield and showing a healthy skepticism about the data we consume is a duty and skill that deserves our attention, right down to that last crab leg.

December 20, 2017

When I read the recent headline that our nation’s primary public health agency, the Centers for Disease Control and Prevention (CDC), has been “prohibited” from “using seven words in official documents used for next year’s budget,” I found myself stomping around the house in disbelief.

As clarified by the CDC director, the truth of this news is probably less provocative than the face value of that headline.  And yet, the preponderance of evidence points to an ongoing and relentless effort to undermine science and scientific principles by our political leaders.  The proverbial last straw has landed on this camel’s back.

In 1996, a federal budget bill stated that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”

Subsequently, Congress eliminated funding for Gun Violence Prevention Research at the CDC.  Funding declined from $2.6 million in 1996 to zero in 2014, 2015, 2016 and 2017, despite a request for $10 million for each of those four years.

This lack of funding prevented scientific research that may have helped address firearm violence in this country, like a 2009 study of suicide rates in California that was funded by local Tuolumne County dollars to identify that, over the prior decade, for every firearm-related homicide in rural parts of the state, there were approximately four firearm-related suicides.

A disrespect for science can cause politicians to blunder into the realm of pseudo-science in response to public outcry, designing legislation with good intentions but with disastrous results.

In 2001, AB 487 was approved by Governor Davis requiring physicians in California to receive 12 hours of training in pain management because of a perception “that physicians consistently fail to manage their patient’s pain appropriately” in part due to “…undertreatment and undermedication.”

The passage of this bill coincided with the release of new opiate medications by pharmaceutical companies.  The encouragement to prescribe long-acting narcotics provided by AB 487 in conjunction with savvy marketing by pharmaceutical companies helped pave the way to today’s opiate addiction crisis.

Pseudo-science and ideological convictions may even misguide us to oppose sound science.  The trail of scientific discovery is littered with the lives of scientists whose sacrifices have resulted in the eradication of smallpox, travel into space, the control of yellow fever and endless research that has either proven or disproven contemporary theories.

To ignore the practical benefits of new discoveries discounts the sacrifices of these modern explorers.  If such neglect aggravates global climate change or results in a chronically ill child contracting an unnecessary infectious disease in school, it is nothing short of tragic.

Scientists must also bear some of the blame for public skepticism.  Real science is humble.  While scientists are generally superb at describing their fields of expertise, they are often not so good at translating their knowledge to the masses.  Science has unfortunately abdicated marketing to the corporate world that stands to prosper from the sales of products and services that are the fruits of science.

Here in Tuolumne County we are trying to change that.  A program called the Exploratorium of Health Care Careers will visit every public school in the county this year.  It is also active in Calaveras County and will be starting in Merced County this spring.

The program is made possible by an intrepid group of volunteers from many scientific and educational backgrounds who are seeking to introduce local 7th, 8th and 9th graders to the wonders and rewards of careers in science and health care.

But to bring new generations into those fields we must encourage students to ask questions.  They must shed their fear of asking the “wrong” question.  We cannot do that if our leaders prohibit our best scientists from asking certain questions or “using seven words” – or for that matter even one word – in their quest to understand our world better and to improve our lives for tomorrow.

If we accept this kind of scientific censorship we degrade the quality and integrity of our science and lower the expectations of tomorrow’s scientists.

In today’s world, with all its diversity, we need to instill our youth with evidence-based and science-based reasoning, so that tomorrow all of us – from the vulnerable fetus to the transgender community – can benefit from opportunities that represent our entitlement.